Policyholder Services

Does OMIC require that cataract surgery be performed only in an accredited facility?

Due to concerns regarding the risk of endophthalmitis or other serious, vision-threatening complications associated with intraocular surgery and the difficulties the company would likely experience defending a resulting claim if elective intraocular surgery procedures were performed in a setting that did not meet existing standards for sterile conditions, OMIC adopted an underwriting requirement that RLE and phakic implant procedures be performed only in a hospital or outpatient surgical center approved for cataract surgery (i.e., certified by Medicare or accredited by one of several national accreditation organizations).  Such procedures may not be performed in the physician’s office, laser refractive center, or other facility that does not meet the standards for sterile conditions as required for accreditation.

In addition, OMIC would be reluctant to insure an outpatient surgical facility in which cataract surgeries were performed if such facility were neither accredited nor Medicare certified.

While OMIC has implemented underwriting guidelines for coverage of OSFs and refractive surgery procedures, the company has not established requirements regarding therapeutic procedures such as cataract surgery.  There are no policy exclusions or underwriting requirements that prohibit performance of cataract surgery in a non-certified, non-accredited facility.  However, from a risk management perspective, we encourage insureds to perform intraocular surgery only in appropriate, approved settings.

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